PORTAL SYSTEM THROMBOSIS AFTER SPLENECTOMY FOR NEOPLASM OR CHRONIC HEMATOLOGIC DISORDER - IS ROUTINE SURVEILLANCE IMAGING NECESSARY

Purpose: This study was undertaken to assess the frequency and sequela e of portal system thrombosis (PST) after splenectomy in patients with cancer or chronic hematologic disorders and to determine whether rout ine surveillance imaging for this potential complication is warranted. Method: The radiology reports of 203 consecutive patients with cancer or chronic hematologic disorders who underwent splenectomy between Ja nuary 1990 and January 1997 were reviewed. Imaging examinations and me dical records were reviewed for those in whom PST was found after sple nectomy. Results: One hundred twenty-three patients (60.6%) underwent CT (n = 88), sonography (n = 10), or both (n = 24) after splenectomy; one other patient underwent MRI. Twelve of these patients (9.8%) had t hrombosis of the splenic, portal, and/or superior mesenteric veins. Th eir underlying diseases were myelofibrosis/myelodysplastic syndrome (n = 8), lymphoma (n = 3), and leukemia (n = 1). At follow-up imaging (o btained in 10 of the 12 patients), PST had resolved (n = 5), worsened (n = 2), improved (n = 1), remained unchanged (n = 1), or resulted in cavernous transformation of the portal vein (n = 1). Nine of 12 patien ts were symptomatic. No patient died of PST. Conclusion: PST was an un common and typically unsuspected finding after splenectomy in this pat ient population, and no serious sequelae of PST were found. Routine su rveillance imaging for PST after splenectomy does not seem warranted, but in symptomatic patients (particularly those with myelofibrosis/mye lodysplastic syndrome), a high clinical suspicion and a low threshold for obtaining imaging examinations are needed.